Usuaria discusión:Jaluj/Taller Wikiquote en el hospital

I would like to especially thank User:Saintfevrier. None of this would have been possible without her previous effort and work in Grants:IEG/Wikitherapy. She has been a model of inspiration for me and my work with patients at the hospital.

Goals

The main goal of this Wikiproject is to encourage patients at the hospital to create and increase the number of articles on Wikiquote in Spanish by enabling them to improve the quality of the content of famous phrases. Those patients who have been hospitalized or who are undergoing some type of outpatient treatment have here a space of assistance for editing and emotional contention.

Preparation

At Wikiquote

First, I ran for administrator in at Wikiquote and I was elected with 100% of the votes. Then I created a page for the wikiproject, Taller de TICs. Wikiquote en el hospital, that means Wikiquote at the hospital, and the coming out was when I presented the working group on the notice board of Wikiquote: Presentatio. The presentation was well received and we received several messages of support from users and some offers of collaboration.

At the hospital

The first step was the project implementation at the hospital. It is a public hospital offering free care. The course was completely free for all patients. I wrote a project and showed it to the Director of the hospital, the Outpatient Director, the Coordinator of Day Care Hospital, and the Chiefs of other Departments. I had talks with all of them. I began writing a survey to be carried out among the staff asking if they knew about The Wikimedia's Project and trying to gauge their acceptance to this project. I also had conversations with some professionals, physicians, psychologists, social workers and nurses. I asked a designer to design some banners which I set up at the entrance and on the walls of the computer laboratory. They can be seen in the photos taken at the lab.

Recruitment of participants

The second step was to recruit participants. That was the most difficult task because of staff reluctance.

I began talking with the Chiefs of each Department to recruit participants among the patients of the School, the Day Care Center and the Adolescent Department. I had interviews with the staff of the Day Care Hospital in the morning shift and the School. The school refused to refer students because it would require special authorization from the Ministry of Education. The bureaucratic procedures were so many and I had to go so far that I did not start them. Day Care Hospital in the morning shift refused to refer me patients, so I had interviews with the staff of the Day Care Hospital in the afternoon shift and with the Outpatients Director and the staff of the Department of Adolescence. They promised me to refer me patients but, until now, only the Day Care Hospital in the afternoon shift referred patients to the course. It was very difficult to begin the work, but I had the support of the Chief of Staff at the Department of Adolescence and he talked with the Hospital’s Director who liked the program. At first, only the Chief of Staff at the Department of Adolescence gave me a referral of one patient, so I started with only one patient. It was an arduous task to convince professionals to give referrals of patients to the course.

Each time a patient was referred to me I interviewed him or her with questions regarding their expectations for the workshop and I took the UCLA Loneliness Scale to measure their perception of loneliness. Until now, all the patients are adults, so I do not need to ask parents or legal tutor's written permission to get data and to take photos of the participants. The elderly patients signed the written informed consents themselves.

Implementation Methodology

Beginning of the course

I began the preparation of the equipment, checking if the wifi connection was working and if the computers were okey.

I started with a single patient who asked questions that I had not thought of. Later, other patients joined the group. When the first new user was created, we started by exploring Wikimedia Commons. I lent them a camera and we started taking photos of the hospital hoping to someday create the hospital's article in Wikipedia. I explained them how to upload the photos to Wikimedia Commons and we began to upload images. These photos have also been used for the Service's website and the hospital's blog. We created the category c:Category:Hospital Marcelo Torcuato de Alvear and, until now, 52 new media files were uploaded in this category. Some of the photos have been used in the web site of the Unit of Adolescence. The banners were uploaded to other category.

I introduced them to policies and guidelines but that was so difficult to them that I've decided to go slowly. The manual of style was the most difficult item to be understand.

We began editing low quality articles. That allows them to make mistakes without facing conflicts between them and veterans users. The work on these articles gave me the first evaluation of the individual performance of every patient.

When we decided to start a new page, to avoid problems with the formal criteria, I taught them how to use the input box that we have to jump immediately to an edit page pre-filled with an appropriate template with standard Wikiquote look. I also told them to place the template {{under construction}}.

I began exploring and identifying the patients' interests and preferences. Some patients brought books and a topic, but some did not know about what they wanted to write so sometimes I picked a topic. For example, I proposed writing about women and they created articles about women's phrases.

I taught them how to send an User Talk message and how to interact with other users but they did not use it very often. They mostly edited alone.

Surveys and interviews

When I took surveys among the staff, I asked them if they knew any Wikimedia Projects. Most of them only knew Wikipedia as readers, but had never edited. None knew nothing about Wikimedia or Sister projects of Wikipedia. I took interviews with the staff of the hospital to explain to them the scopes of the project. I spoke with doctors, psychologists, psychiatrists, occupational therapists, social workers and nurses. I was very disappointed with the results, since I could not find even one member of the staff who knew anything about the Wikimedia Foundation or Wikiquote. Some of the professionals had heard about Wikipedia, but they did not know that anyone can edit. All of them thought that Wikipedia is written by specialists. I had to explain to all of them what Wikimedia Foundation does, what is our mission, our scopes, our commitment, our work around the world, why we do believe in free knowledge and educational content. The interviews with the staff at the Day Care Hospital during the morning and the School were frustrating. They fear that the work might harm the patients.They feared it might be novice. I couldn’t believe it.

The patients did not know Wikimedia activities nor Wikiquote. When we began to look for sourced quotations from notable people with Google they used Wikipedia or Wikiquote, even if they did not know them, as a resource. I had to explain them, carefully, what to do.

Some patients told that they browse the web almost everyday but they do it mostly to visit social networks like Facebook or listen to music at YouTube. All of them have a FB account, but nobody talk to them there or give them a like, and a Gmail account but none receive any e-mail from friends. They had never added content or information to the web. They said, for example, «I do not know where I can get information», «I do not know what I could publish», and «I cannot do it».

Answering the question, how would you describe your relationship with those around you in your daily life and the internet? they answered: «I have no relation nor link» or «I am not very popular».

The results of UCLA Loneliness Scale were very interesting since patients tended to lie, not on purpose, but as a kind of misrepresentation of reality. They said that they had a lot of friends but they could not name anyone. When I asked them about those friends they named Facebook contacts. When I inquired more about the match with those contacts they confessed that there really was no link whatsoever. For example, a patient commented that she uploaded phrases to Facebook but no one commented her posts or gave her a like. She told me: «I think that I write on the air, nobody reads my posts, I'm not very popular on Facebook». So even if they said that they were not alone they had no effective relationships with peers or partners.

Frequency and duration

There have been changes on the original plan, as different needs emerged in practice. The course was supposed to consist of a weekly meeting of three hours duration but I realized that I had problems with that. The duration was very long, they got tired and the frequency was not enough. If they spent a long time without working they forgot what they had learned. More specifically, their interest as well as their ability to comprehend the information presented decreased with an increase of the duration, so, I've decide to see them more often but with a shorter duration of each session. I began to see them twice a week and sometimes three times a week but each class lasted one hour and a half and not three. Patients tended to learn better and to retain more of the information when they worked less time and more often. Patients responded pretty well and I confirmed that this approach facilitated patients learning. More classes and greater possibilities to make mistakes, trial and error improved their confidence and trust.

Images

The patients uploaded 52 photos to Wikimedia Commons. One category was created. c:Category:Hospital Marcelo Torcuato de Alvear at Wikimedia Commons. We are still uploading photos.

I've also created four logos and banners to use during the course that were also uploaded to Commons.

Many of the photos uploaded to Wikimedia Commons can be seen at the web page of the Adolescencia Alvear Department, the article in Spanish Wikipedia Hospital de Emergencias Psiquiátricas Marcelo Torcuato de Alvear and w:Hospital de Emergencias Psiquiátricas Marcelo Torcuato de Alvear in English Wikipedia.

Implementing classes of editing

The course began in November taking photos, uploading in Commons, learning the principles of Wikiquote and how to access the needed information and sources. At the beginning the patients were afraid of editing or publishing so we worked with Word and we uploaded the article when they felt more secure or safe.

Some of the patients attendance was not constant. Sometimes they came and sometimes they did not come. Some patients disappeared from the course and after a while they returned. Absences were due to their own pathology. When a patient did not feel well he or she could not attend the course.

At the beginning, the training was held in 3 two-hour sessions per week during the morning, but I had to change the duration and frequency and I have to also go to the hospital during the afternoon because some of the patients from Day Care Hospital with partial hospitalization were interested and I had no support from the staff during the morning.

One of the patients entered each class very upset, saying that he would not be able to drill his head with his thoughts and that he got very nervous. He said that he felt suffocated, that he could not breathe and that he would not be able to come any more. Soon after starting to work, he forgot everything, he concentrated and he began to work pretty well.

Another one listened to voices that told him that he would not be able to do it, that he would not know how to edit, that Wikiquote was too difficult for him, but once the class started, after his first edit, he calmed down. He had a hard time having ideas, so I had to help him and guide him in every single step of the editing. Little by little he began to remember some steps. He could not think about what topics to work on, but he showed me how he did to search for books in Google Doctors so he could get some ideas out there. I pointed out that he also has something to give and to teach others because I had learnt that Google Doctor existed. He felt very happy about that.

Another patient, even if, at the beginning, it was very difficult for him to understand how to contribute, he improved 5 existing articles at Wikiquote and he managed to created 5 new articles. His father commented that he felt very proud about his son's achievements since he could do on the web things that the father did not know. He pointed out that he admired his son because of the articles at Wikiquote and the son felt very good with that comment. That was touching for me.

I had to create small and manageable tasks every class. I had to pay them personalized attention. The teaching was very personalized, much more than with a healthy person. The time was used mainly to explain them basics of editing, formatting and how to add citations. It was so hard for them to understand the instructions that we wrote in Word before they could upload and publish an article.

At Wikiquote, the project had great acceptance among veterans users. The response from users could not have been better. They showed great support to the project and, to my surprise, accustomed to conflicts en Wikipedia, they helped the newbies in their editions.

In December we began editing target articles. Later on we began to create new articles. We also created one category tag to upload the photos of the course to WikiCommons, named Category:Hospital Marcelo Torcuato de Alvear.

I taught them how to browse and to search an article. I was monitoring and supervising patients's editing all the time. The teaching was very personalized, often working with a single patient at a time. I had to make suggestions because they did not know what to choose as a topic to edit. In line with the international edit-a-thon holding by BBC's 100 Women, to increase female biographies on Wikipedia, I invited them to use BBC ‘100 Women Of 2016’ Highlights as a source. I helped them to improve their editing. I also proposed them to narrow the gender gap creating articles about other women.

For one patient, punctuation did not exist; he wrote as he spoke, all together. Details, like learning to use a quotation mark, were very complicated for him. I had to work very personalized to help him to understand the beginning and the endpoint in sentences.

Another patient could not differentiate the automatic responses of a bot with the messages of a human user and answered to all in the same very polite way.

Because we started late, I decided not to close the course on February and we continue editing during March.

Notifications

The page Wikiquote en el hospital was created at Wikiquote. The working group was presented on the notice board, here. Notifications were sent the es:Wikiproyecto:Psicología, here, and the es:Wikiproyecto:Medicina, here.

The written project were sent to the Director of the Hospital and the Chiefs of Staff of all Departments. It was also sent to the Investigation and Teaching Committee at the hospital.

Obstacles

I will adress some of the issues and obstacles that I faced during the implementation of the project.

At Wikiquote

Obstacles and implementation issues at Wikiquote can be placed into two categories:

Software

The software was not very kind to the patients. Something that for us, veterans and "normal people", looks very easy, for them was extremely difficult. We also faced some difficulties with the browser, because Mozilla Firefox suddenly stopped showing the buttons and we had to go to Chrome.

Patients pathology

I teach editing Wikipedia in the University and different editathons and it was much easier for newcomers to understand directions about editing. For these patients it was much more difficult than "normal" people to understand the instructions.

In one case, her concerns were primarily related to whether participating in the course would result in a problem with her church. She had recently opened her heart to God, she had a born-again experience, she had converted to evangelism, God walked with her and talked with her, so now she feared that the evangelical church could read her user page and learn that she liked Korean music, something that was strictly forbidden for them. They only allowed her to listen to christian music. Even if I explained her that with the user name that she had chosen no one could recognize her, she was a bit paranoid about church members reading her user page. She never accepted to be photographed and finally she could not created one article from zero.

At the hospital

Obstacles and implementation issues at the hospital can be placed into three categories:

Bureaucracy

The first obstacle that I faced was the bureaucracy of the institution. The onset was delayed due to the hospital bureaucracy. The Ethics Committee was to accept the workshop and its feasibility within the hospital. I could not close the course as I wished with an event in the hospital. I needed an official permit for every single step that I wanted to do. I could not shoot a video with the most relevant moments of the process because I had not official permission. When I finally got the permission I shoot the video.

Social obstacles

The second obstacle that I faced was acceptance. Only with the acceptance from the staff, the necessary support can be obtained. At the beginning there was some reluctance from the staff who did not know well what the Foundation's projects were about. Mental health professionals have been dubious about the project. There was a lot of reluctance among them. I had to invest long time explaining the staff of different units Wikimedia's mission. I had to talk with professionals from different units to try to convince them to refer patients to the course. Most of them were very skeptical. They showed suspicion towards Wikipedia and towards the use of the internet by the patients. They said that patients already knew how to surf the web and did not need help. However, the interviews showed that patients' use of the Internet was neither productive nor healthy. There were patients trying to learn to hack or they took time to visit pages of photos of naked women. One of the biggest concerns identified by professionals were «Can it hurt patients?» «What if he has a psychotic breakdown by editing? What you are going to do?» «Better start learning Word and not with something so complicated as Wikiquote».

I also had meetings with staff from Ambulatory Unit but, even if they promised me to give me referral of patients, they never show up. One social worker of the Day Care Hospital of the afternoon showed interest. I had a meeting with the Chief of Unit and the whole staff and they promised to send me patients. My first patient came from the Chief of Adolescent Unit but the second was referred from Day Care Hospital afternoon shift.

Technical obstacles

Technical obstacles deal with issues relating to the physical components that make up the infrastructure like the computers or the connection speed. At the beginning, the hospital provided me a laboratory room with one desktop computer but the free wifi access didn’t work very well. We had a lot of problems so I had to use my laptop with the wifi of my Smartphone. Buy then my laptop was broken. The hospital promised me to fix the connection but it did not happen. The monitor of the computer that I was using was broken and was never repaired. I had to wait one week until they change the room to work and they allowed me to work in the consulting room with four computers. I needed a key to be able to enter in the computer cabinet but I needed a copy of the key so I do not have to depend on someone else to open the door. But we did not find a locksmith that had that key model, therefore I could not make a copy of the key. For some weeks I depended that the person who had the only key arrived that day at the hospital or was unoccupied to be able to open me.

This is the computer lab where I work. The photo comes from Wikimedia Commons. The computers were new, that was great, but the wifi connection did not work all the time. The second day we had no internet connection and we had to work on Word without internet. When we had the connection was too slow and did not cover all the computers but one at a time.

Outside the stipulated time, patients could not access the hospital's computers as I wanted.

Outcomes

As you can see here, we don't have many active editors in Wikiquote in Spanish. If you see our statistics, we don't have new articles very often, sometimes months go by until a new article is created and sometimes we've got only one article per day. If we think that the average number of edits and the average number of new articles are so low, the number of articles that the patients have created in this project make a difference. You can also see a lot of photos taken by the patients in this web site.

Target outcome.	Achieve outcome
To recruit and encourage beginners to create and increase the number of articles in Wikiquote in Spanish.	8 new users
To train beginners to improve quality of Wikiquote content.	Done
To upload images of the course and the process to Commons	56 photos uoploaded
To upload videos of the course to Youtube and Facebook	6 videos uploaded to Youtube and Facebook
To create a project page on wiki.	Done
To create new articles	18 new articles
To create awareness and increase visibility and understanding of the Wikimedia projects.	Done
To research about the beneficial effects of editing as being part of a bigger community	In process
To take surveys and the UCLA Loneliness Scale	Done
Writing and publishing the research in a professional journal.	In process

Total number of new contributors	8
Total number of images uploaded to Wikimedia Commons	56
Number of categories created in Wikimedia Commons	1
Number of articles created in Wikiquote	18
Number of the uploaded pictures featured in webpages outside the Wikimedia domain.	20
Number of articles that were improved at Wikiquote	23
Number of people participating including staff	13
Number of images uploaded to Wikimedia Commons embedded in Wikipedia articles.	5 Wikipedia in Spanish article Hospital Alvear and 5 files at Wikipedia in English article Hospital Alvear.

Contributor	New Article
User:Luelizabeth	El secreto (libro).
User:Festina99	Giovanni Battista de Rossi.
User:Festina99	José Mauro de Vasconcelos.
User:Festina99	Cuentos de la selva.
User:Festina99	Laura Esquivel.
User:Festina99	Elsa Bornemann.
User:TatyLC
User:SAHEPTA	María Elena Walsh.
User:SAHEPTA	Paula Hawkins.
User:SAHEPTA	La chica del tren.
User:Hepa3	Winnie Harlow
User:Hepa3	Eva Joly
User:Meshugaim	Porfirio.
User:Meshugaim	Nadiya Hussain.
User:AllvearSAH	Colette Dowling.
User:AllvearSAH	El complejo de Cenicienta
User:HospAlve	Iskra Lawrence
User:AllvearSAH	Estela de Carlotto.
User:HospAlve	Ágnes Heller
Category created at Wikimedia Commons.	Hospital Marcelo Torcuato de Alvear.
Article Spanish Wikipedia	w:Hospital de Emergencias Psiquiátricas Marcelo Torcuato de Alvear.
Article English Wikipedia	w:Hospital de Emergencias Psiquiátricas Marcelo Torcuato de Alvear.

Number of posters for Conferences	3
Number of videos	1
Total number of learning patterns	2
Learning pattern	Grants:Learning patterns/Wikimedia young projects in therapy settings with psychiatric patients.
Learning pattern	Grants:Learning patterns/Creation of an editing workshop or course with patients in an institution.

Talk page with the community	Wikiquote discusión:Wikiquote en el hospital
Page of the project	Wikiquote:Wikiquote en el hospital
Page of the blog	Wikiquote en el hospital
Page of the blog of Wikimedia Spain	[ In process]
Page in Facebook	Facebook
Paper V Jornadas del Hospital de Emergencias Psiquiátricas Torcuato de Alvear	Done, to be presented May 24 2017
Paper VII Encuentro de la Liga Latinoamericana para el estudio del TDAH (LILAPETDAH)	Done, to be presented June 13 and 14 2017, Sociedad Científica Argentina
Paper XVIII Congreso de la Asociación Argentina de Psiquiatría Infanto Juvenil y Profesiones Afines (AAPI)	Done, to be presented June 15 and 16 2017, AAPI
Poster to be presented	Wikimania 2017
Video	Video 1.
Video	Video 2.
Video	Video 3.
Video	Video 4
Video	Video 5.
Video	[ Video 6] in process.

I cannot say that I've met all my goals but I feel satisfied how the project went. It was a laborious work to recruit patients to follow the course. It was arduous to encourage beginners to create and increase the number of articles in Wikiquote in Spanish but we have now 18 more new articles, which means a lot in a project with so few users contributing.

I created the project page on wikiquote which is growing and expanding. I could not use the twitter of the Department of Adolescence since they are not using it, but I could write an article about the project at their official website. I uploaded many photos in the FB that were seen by many people.

I also wrote about the course in my blog on WordPress. I'm preparing a poster to present at a Conference in Buenos Aires and another one to be presented at cientific conferences and at Wikimania 2017, in English and Spanish.

One of the most important outcomes that was achieved was the awareness, visibility and understanding of the Wikimedia projects among professionals. Now I can talk with members of the staff and they know what I am doing, they understand Wikimedia's missions and scopes, they know that anyone can edit Wikiquote or Wikipedia. The Chief of Staff of Adolescent Unit offered me to prepare a project to work with doctors and psychologists teaching them how to contribute to Wikipedia on psychiatric topics. I am even working with a patient who was sent by another hospital, from the Day Care Unit of the Hospital Posadas.

Unfortunatly, I did not see any improvement in their possibility of integration in the community. They still did not learn how to negotiate with other editors. I still could not setup an active editing group inside the hospital but I do have hope. I believe that boths things need more time. This was a short pilot and I hope it will grow up.

I was able to get feedback from the participants and from the professional staff. I have shoot a video interviewing patients, relatives and professionals talking about the project. I could do some Global Metrics.

One outcome that made me happy it was that the group of veteran editors showed a great interest in the project. They are making proposals on how to improve the project. Several users offered me to collaborate online and to help the patients. The project had a great acceptance among the users of Wikiquote, who have offered us an incalculable support that can be seen in this page. I am afraid that this would not have happened if I had worked on Wikipedia in Spanish where the level of conflict is high.

I am currently taking interviews and recruiting patients to begin a new group. I hope to continue with the course. I am also researching about the beneficial effects of editing as being part of a bigger community and I hope to continue doing it. I am still writing a paper in Spanish with the results of the course and the research.

I am writing an article for the Wikimedia Foundation blog. I have also created the article w:Hospital de Emergencias Psiquiátricas Marcelo Torcuato de Alvear at Wikipedia and 5 images uploaded to Wikimedia Commons by the patients were added to the article in Spanish and the article in English.

Grant funds used

To make the T-shirts they demanded a minimum of ten shirts that cost too much so I had prioritized to set up banners on the walls of the computer laboratory.

Project Leader fees amount US$1800.
Certificates to recognize participants contributions, US$10.
Designer who draw the banners, US$120.
Impression of the banners, US$25.
Total amount used US$1955.

Conclusions

This was a very enriching experience for me, both as a professional and as a person. Patients's perceptions were not homogeneous but most of them are grateful to have participated in the experience. One patient found it useful because the negative thoughts, which told him that he would not be able to do anything, disappeared when he managed to began to edit.

The learning evidence shows relatively little growth in ability to implement critical skills. Learning for them was much slower than for other people and many patients dropped out. Nevertheless, I can point out some improvements.

One patient commented that the most difficult situation for him it was the punctuation. He wrote as he spoke, without capital letters or minuscule letters, without any sign of punctuation. Neither commas nor end dots in the sentences. A long work was to teach him that the sentences have a beginning and an end, which should begin with capital letters and end with a dot. The patient learned to use the quotation marks and to differentiate the different levels of a sentence within a text. The idea of a beginning and an end also influences his perception of the world. He appreciated very much the fact that it was beneficial to his learning the use of grammar rules, to learn that phrases have a beginning and an end, to learn where to put the punctuation marks, to learn the use of commas and upper case differences.

A female patient spent the whole week searching for famous phrases on the web to bring them to the workshop: «Before I was sleeping all day, but now I'm entertaining looking for phrases and annotating them». She always had published phrases and quotes to FB but no one read them or answered her, she had never received a like, so she was happy to upload them to Wikiquote: «I've always thought that I was writing to the air but now all the phrases that I've collected will serve me for something».

Another patient recognized the benefits of being able to revisit the article as many times as he needed to improve the writing. I also observed patients being able to apply what they had learnt because they were able to use the knowledge they gained, specially when they created an article from zero. I see that we could improve quality of Wikiquote content.

The difference between what the patients said and what really happened to them as to their loneliness or number of friends were significant. For example, when evaluated by the solitude test, some patients claimed to have many friends. When the I asked them in depth, I found out that they refered to friends of Facebook. If asked them how often they communicate with these friends they told me that almost never, that they did not receive likes and that nobody read their posts. One patient told me that she thought that she was writing to the air. This difference is not due to the patient lying to the interviewer, but to a distortion in their reading of reality. One patient, diagnosed with Asperger Syndrome, when he received the messages of the bots he was very happy, he said that it seemed very polite and then he began to put into his editing summaries very educated as «dear readers». He could not differentiate the comments of living people from the messages of a bot.

Towards the end, the resistance of the professionals was significantly reduced and I received a lot of support. I suggest that consulting the staff during the design phase is an important way of overcoming the obstacles. I believe that this project present real opportunities to engage and empower patients and create novel approaches to both assessment and intervention for mental health problems. The use of digital technology to educate patients is an important driver of patient engagement and it can help move from the patient as a passive recipient of knowledge to one actively engaged in editing and creating knowledge.

I would feel very gratified if other workshops appear in other countries or in other hospitals if the foundation supports them, and I hope that User:Saintfevrier will return her work with patients in Greece.

I am now recruiting patients and I expect to begin a new course on May with a new group of users.